SENATOR MURPHY ANNOUNCES $19 MILLION INVESTMENT TO COMBAT HEROIN AND OPIOID EPIDEMIC IN HUDSON VALLEYLegislation is part of $213 million statewide investment package signed by Governor Cuomo

Long Island, NY – When the use of heroin and opioid began to increase dramatically across the Hudson Valley, Senator Terrence Murphy was the first elected official to call for legislation to stem the rising tide of what would become an epidemic. He took action, first by serving as Co-Chair of the State Senate’s Task Force on Heroin and Opioid Abuse and by passing legislation to promote prevention, treatment recovery and education to help citizens caught in the grip of addiction.

Senator Murphy’s diligent efforts came to fruition today when he stood alongside Governor Andrew Cuomo as the Governor signed legislation investing over $200 million to combat the plague of heroin and opioid dependency in New York State. The Mid-Hudson Valley will receive $19 million.

“Too many lives have been ruined by the influx of heroin and opioid invading our communities,” said Senator Murphy. “No one is immune to this epidemic. We now have the ammunition to fight for our children and our families. This increase in funding gives us the financial clout to empower our communities through enhanced prevention, treatment and recovery options.”

In 2016, the Governor signed into law a comprehensive plan first put forward by Senator Murphy’s task force to increase access to treatment, expand community prevention strategies, and limit the over-prescription of opioids in New York. Just last week, United States Senators Kirstin Gillibrand and John McCain introduced identical legislation on the federal level, proving the measures passed stand as a national model in America’s efforts to combat this terrible epidemic.

The FY 2018 Budget builds on this progress by investing over $200 million to support prevention, treatment and recovery programs targeted toward chemical dependency, residential service opportunities, and public awareness and education activities. The funding supports opioid treatment slots, 24/7 urgent access centers, community coalitions, family support navigators, peer engagement programs, adolescent clubhouses and community and outreach centers.

Overdose deaths involving all opioids continues to rise in New York. The number of opioid deaths in 2015 doubled compared to the number in 2010 and the number of heroin involved deaths in 2015 was five times of that in 2010. In addition, there has been a higher increase in opioid deaths between 2010 and 2015 outside of New York City, with sharper increase in heroin related deaths outside of NYC.

Since Senator Murphy arrived in Albany, a series of aggressive reforms to combat heroin and opioid addiction have been implemented, including:

Builds on Governor’s 2016 Legislation to Limit Over-Prescription and Eliminate Barriers to Treatment

Governor Andrew M. Cuomo today signed legislation investing over $200 million to combat the heroin and opioid epidemic in New York. In 2016, the Governor signed into law a comprehensive plan following the recommendations of the Heroin and Opioid Task Force, to increase access to treatment, expand community prevention strategies, and limit the over-prescription of opioids in New York. The FY 2018 Budget builds on this progress by investing over $200 million to support prevention, treatment and recovery programs targeted toward chemical dependency, residential service opportunities, and public awareness and education activities.

“We have made significant progress in combating the devastating heroin and opioid epidemic in New York, but this crisis continues to plague our communities and we must do everything in our power to combat each facet of this complex health emergency,” Governor Cuomo said. “This comprehensive investment addresses each component of heroin and opioid addiction – prevention, treatment, and recovery – to help individuals and families break this cycle of misery, save lives and create a stronger, healthier state for all.”

Overdose deaths involving all opioids continues to rise in New York. The number of opioid deaths in 2015 doubled compared to the number in 2010 and the number of heroin involved deaths in 2015 was five times of that in 2010. In addition, there has been a higher increase in opioid deaths between 2010 and 2015 outside of New York City, with sharper increase in heroin related deaths outside of NYC.

Given this epidemic, the FY 2018 Budget invests $213 million to address the heroin and opioid crisis in New York, representing an increase of over 100 percent from FY 2011. The investments include:

$145 million for community-based providers

$65 million for 8,000 residential treatment beds

$9 million for housing units

$41 million for opioid treatment programs

$21 million for outpatient services

$9 million for crisis/detox programs

$27 million for state-operated addiction treatment centers

$6 million for Naloxone kits and training

$25 million for expanded programs, including family support navigators, peer engagement and 24/7 urgent access centers

“This administration, under the leadership of Governor Cuomo, has taken aggressive action against heroin and opioid addiction,” Lieutenant Governor Kathy Hochul, Co-Chair of the Governor’s Task Force to Combat Heroin and Opioid Addiction, said. “The additional influx of funding provided in this Budget will ensure even more individuals, families and communities will get the help they need to fight this deadly epidemic. This plague has claimed too many lives across our state.”

“This comprehensive investment addresses each component of heroin and opioid addiction – prevention, treatment, and recovery – to help individuals and families break this cycle of misery, save lives and create a stronger, healthier state for all.”

Governor Andrew M. Cuomo

A regional breakdown of the FY 2018 Budget funding is available below:

Capital Region – $7 million

Central New York – $5 million

Finger Lakes – $12 million

Long Island – $23 million

Mid-Hudson Valley – $19 million

Mohawk Valley – $5 million

New York City – $94 million

North Country – $7 million

Southern Tier – $3 million

Western New York – $16 million

Governor Cuomo’s Previous Initiatives

Since 2014, Governor Cuomo has implemented a series of aggressive reforms to combat heroin and opioid addiction, including:

Limiting initial opioid prescriptions for acute pain from 30 to 7 days

Expanding insurance coverage for substance use disorder treatment

Increasing access and enhancing treatment capacity across the state, including a major expansion of opioid treatment and recovery services

Implementing the comprehensive I-STOP law to curb prescription drug abuse

Launching a public awareness and prevention campaign to inform New Yorkers about the dangers of heroin use and opioid misuse and the disease of addiction

Assembling a task force to propose initiatives to tackle the heroin and opioid epidemic

Dutchess County Sheriff Adrian “Butch” Anderson is hosting a fundraiser for End Overdose in the Harlem Valley (The Prevention Foundation Mid-Hudson Valley – Harlem Valley Coalition) Friday April 7, 7:30 – 11 pm at The Links at Union Vale. There will be a silent auction, food and drinks, and live music by “DJ of the Year” finalist Mike Alevras of HVE Associates.

“Opioid addiction is at epidemic proportion in the Unite States. Community coalitions like End Overdose in the Harlem Valley are working with local businesses, non-profits, hospitals, schools, law enforcement, and residents to make a difference in how this epidemic affects our communities, in eastern Dutchess County,” said Dutchess County Sheriff Adrian “Butch” Anderson. “Join us and help us raise money to take action and create change.”

Elaine Trumpetto, Executive Director CAPEDC

“We are in the midst of a public health epidemic-locally, regionally, statewide, nationally and globally,” said Elaine Trumpetto, Executive Director of CAPEDC. “Public health is always the beneficiary of education that builds awareness and supports informed decision making.”

According to the federal Drug Enforcement Administration (DEA), more than half of all drug overdose deaths nationwide were caused by opioids in 2014, and the Centers for Disease Control (CDC) says since 2000, the rate of deaths from drug overdoses has increased 137%, including a 200% increase in the rate of overdose deaths involving opioids (opioid pain relievers and heroin).

Tickets for the event are $40 per person or $70 a couple. Please RSVP to endoverdose@gmail.com or call The Links at Union Vale 845-223-1002.

Naloxone blocks or reverses the effects of opioid medication. (Seth Herald for NPR)

Aetna, one of the nation’s largest insurance companies, will remove a key barrier for patients seeking medication to treat opioid addiction. The change will take effect in March and apply to commercial plans, a company spokeswoman confirmed, and will make it the third major insurer to make the switch.

Specifically, Aetna will stop requiring doctors to seek approval before prescribing particular medications ― such as Suboxone ― that are used to mitigate withdrawal symptoms, and typically given along with steady counseling. The insurance practice, called “prior authorization,” can result in delays of hours to days in getting a prescription filled.

The change comes as addiction to opioids, which include heavy-duty painkillers and heroin, still sweeps the country. More than 33,000 people died from overdosing on these drugs in 2015, the most recent year for which statistics are available. And it puts Aetna in the company of Anthem and Cigna, which both recently dropped the prior authorization requirement for privately insured patients across the country. Anthem made the switch in January and Cigna this past fall.

Both companies took the step after facing investigation with New York’s attorney general, whose office was probing whether their coverage practices unfairly barred patients from needed treatment. They made this adjustment as part of larger settlements.

This KHN story also ran on NPR. It can be republished for free (details).

It sounds like just a technicality ― a brief delay before treatment. But addiction specialists say this red tape puts people’s ability to get well at risk. It gives them a window of time to change their minds or go into withdrawal symptoms, causing them to relapse.

“If someone shows up in your office and says, ‘I’m ready,’ and you can make it happen right then and there ― that’s great. If you say, ‘Come back tomorrow, or Thursday, or next week,’ there’s a good chance they’re not coming back,” said Josiah Rich, a professor of medicine and epidemiology at Brown University and doctor at Providence-based Miriam Hospital, who frequently treats patients with opioid addictions. “Those windows of opportunity present themselves. But they open and close.”

As these major carriers drop the requirement, treatment specialists hope a trend could be emerging in which these addiction meds become more easily available. In New York, for instance, the attorney general’s office will be following up with other carriers who still have prior authorization requirements, an office spokesperson said. The office would not specify which carriers it will next examine.

Meanwhile, though little research pinpoints precisely how widespread this coverage practice is for drugs that treat opioid addiction, experts say it’s a fairly common practice.

“Just think of any big health insurance company that hasn’t recently announced they’re doing away with this, and it’s a pretty safe bet they’ve got prior authorization in place,” said Andrew Kolodny, a Brandeis University senior scientist and the executive director of Physicians for Responsible Opioid Prescribing, an advocacy group.

How does the problem manifest? Take Boston Medical Center, located in a region that’s been particularly hard hit by opioid addiction. Doctors there wanted to launch an urgent care center focused on this patient population. Less than a year old, the program’s treated thousands of people.

But prior authorization requirements have been intense, said Traci Green, an associate professor at Boston University’s School of Medicine and deputy director of the hospital’s injury prevention center. To help people get needed care ― before it was too late ― the center hired a staffer devoted specifically to filling out all the related insurance paperwork.

“It was like, ‘This is insanity,’” Green said, adding that “navigating the insurance was a huge problem” for almost every patient.

But defenders of the requirement maintain that such controls have value. Insurance plans using prior authorization may view it as a safeguard when prescribing a potentially dangerous drug. “[It’s] not a tool to limit access. It’s a tool to ensure patients get the right care,” said Susan Cantrell, CEO of the Academy of Managed Care Pharmacy, a trade group.

Other large insurance carriers ― such as United Healthcare and Humana ― list on their drug formularies a prior authorization requirement for at least some if not all versions of anti-addiction medication. A spokesperson from Humana said the practice is used “to ensure appropriate use.”

Also, though, it is generally agreed that the practice is used to control the prescribing of expensive medications. Per dose, the cost of these drugs varies based on brand and precise formulation, but it can go as high as almost $500 for a 60-pack dose, which can last a month.

Regardless of intent, critics say, those extra forms and hoops do make it more difficult for patients in need to get these medications ― ultimately, they say, doing more harm than good.

“If you would like a physician to not do a particular treatment, put a prior authorization in front of it,” Rich said. “That’s what they’re used for.”

Meanwhile, addiction treatment advocates and health professionals are hoping to build on what they see as new momentum.

Earlier this month, the American Medical Association sent a letter to the National Association of Attorneys General, calling for increased attention to insurance plans that require prior authorization for Suboxone or other similar drugs.

Minnesota’s attorney general has written to health plans in the state, asking they end prior authorization for addiction treatment. New York has also heard from other states interested in tackling the issue, the attorney general spokesperson said. And another project, called Parity Track, is soliciting complaints from consumers.

They’re arguing based on a requirement that insurance plans, thanks to so-called “parity laws,” must cover addiction treatment, and cover it at the same level as they do other kinds of health care.

The prior authorization requirement “doesn’t meet the sniff test for parity,” said Corey Waller, an emergency physician who chairs the American Society of Addiction Medicine’s legislative advocacy committee. “It’s a first-line, Food and Drug Administration-approved therapy for a disease with a known mortality. Every other disease with a known mortality ― the first-line drugs are available right away.”

But the justification for legal cases like New York’s could get weaker. The 2010 health law, which lawmakers are working to repeal, included requirements that mental health and addiction treatment be considered an “essential health benefit.” If that disappears, robust coverage for addiction could be less widely available, several noted.

Meanwhile, the stakes are substantial, Rich said. He recalled a patient who was taking a version of buprenorphine ― the active ingredient in Suboxone ― who had a brief relapse with heroin. That led to complications in the paperwork for renewing his prescription for treatment.

“Now he’s out of the office, in the street, using more,” Rich said of that case. “Incumbent upon [effective treatment] is the ability to get people started right away. If there’s prior authorization? It’s infuriating.”

WILKES-BARRE, Pa. — For William Lisman, the longtime Luzerne County coroner, the first sign of the coming plague appeared in the hills of northeastern Pennsylvania in November 2015.

A 27-year-old woman from one of the mountain towns surrounding Wilkes-Barre was found dead in her family home.

Lisman suspected a drug overdose. She was young. She had been healthy. There were no obvious signs of trauma. And heroin abuse had been on the rise in recent years.

William Lisman, the Luzerne County Coroner, stands at the county morgue in Luzerne County, Pennsylvania.NBC News

“When a person dies of an overdose, the lungs fill with fluid,” he said. “The victims essentially drown in their own fluids.”

Because autopsies are expensive and time consuming, many coroners faced with cases like these do toxicological tests designed to pick up traces of known drugs to determine the cause of death. But the first test Lisman administered came back negative. So did the second.

So Lisman listed the cause of death as undetermined.

Several days later, a 34-year-old man was found dead in a sleeping bag in the nearby city of Hazleton.

Once again, Lisman suspected a fatal drug overdose. Once again, the tox tests came back negative. And once again, he listed the cause of death as undetermined.

“I remember when it started because it was budget time and they were about to cut my budget,” he said, with a wry chuckle. “At that point the doctor I had been consulting with (about these two cases) told me, ‘Bill, there is something going on here’.”

Like many coroners in smaller counties, Lisman is not a doctor. But he knows about death. A third-generation Wilkes-Barre resident, he and his family ran a funeral home that buried several generations of city residents. He reached out to fellow coroners in neighboring counties to see if they had similar cases.

They had. And the answer was fentanyl, a powerful painkiller the U.S. Drug Enforcement Administration says is 25 to 50 times more potent than heroin, packs 50 to 100 times more punch than morphine, and can be manufactured easily by illegal drug mills. This was the same drug that killed Prince last April.

“I started hearing about fentanyl and how drug dealers were cutting heroin with it,” he said.

Lisman said he had the toxicological tests “tweaked” to detect the presence of fentanyl and “after that, the drug overdoses here skyrocketed.”

Facing a crisis, Lisman called the local newspaper, The Times Leader, last May and sounded the alarm.

“I knew I wasn’t going to stop people from using, but I wanted people to know what they were using,” he said. “This stuff can kill them.”

And it has.

The deadly math in Wilkes-Barre

Last year there were 137 fatal drug overdoses — more than half of them the result of heroin laced with fentanyl — in a county of just 318,000 people.

That death rate is four times higher than New York City.

“Twenty years ago, we might have 12 deaths we determined to be drug deaths,” Lisman said. “This year we are on track for 150 deaths…By our standards, it’s off the charts.”

There have been so many fatal drug overdoses that Lisman, who uses an examination room in the basement of a local hospital to do autopsies, said he has had to “finagle space to put all the bodies.”

“I have only room for two in my cooler,” he said. “There’s room for just 10 more in the hospital’s other cooler.”

The victims reflect the demographics of the county — they’re mostly white, often lower to middle income, Lisman said.

“Age wise, we are across the spectrum, from 20s to the 70s,” he said. “We see everyone from the guy in the flophouse to the hard-working guys or gals who find relief in drugs.”

Also, while heroin users in the past relied on needles, “the vast majority now is being snorted,” said Lisman. “A user doesn’t have to go through the process of injecting now. It makes it easier to use.”

A big part of the reason Wilkes-Barre is grappling with a drug problem, Lisman said, is because this city of 41,000 is just a two hour drive from Philadelphia and from New York City. Interstates 80 and 81 converge just south of the city.

A packet of heroin that sells for $5 in the Bronx can fetch double that in Wilkes-Barre, Lisman said. And if it’s cut with fentanyl, the profit quadruples along with the danger to the users.

“Heroin definitely has its hold on this area,” said Cathy Ryzner, a certified recovery specialist at the Wyoming Valley Alcohol & Drug Services in Wilkes-Barre. “I’ve never seen anything like it. Every time you look in the newspaper and you see somebody died young and at home, you know. You know.”

Patty and Chris Emmett lost their son, Christopher, to an accidental opiate overdose on Aug. 23, 2016.NBC News

Christopher Emmett buried his 23-year-old son, Christopher Jr., in August, although in his case it was due to a lethal mixture of morphine and codeine.

“Every time I hear of somebody dying it’s always with the fentanyl mixed with it — it’s never somebody that just did heroin and died from doing heroin,” he said.

From boom town to boarded-up storefronts

The plague hit Wilkes-Barre as the proud county seat on the Susquehanna River was struggling to reverse decades of decay.

Once a thriving city of 80,000, Wilkes-Barre was built by coal and manufacturing barons who erected stately homes and public edifices like the stunning Luzerne County Court House and the 14-story Luzerne National Bank Building in Public Square. Thousands of Italian, Polish, Lithuanian and Irish immigrants poured into the city to work in the mines and toil in the garment factories.

But the city lost half its population when the anthracite coal mines died in the 1950s and the good manufacturing jobs began vanishing. And in 1972, Hurricane Agnes delivered a body blow to the local economy when it flooded downtown with nine feet of water.

After that, Wilkes-Barre became a city of abandoned buildings and boarded-up store fronts as the remaining residents struggled to find their footing in an economy where the main employers were now government agencies, the local colleges and hospitals.

The recession in 2008 hit Wilkes-Barre — long a Democratic bastion — hard. And when Barack Obama was running for president, hopeful residents voted for him in droves and did so again when he ran for reelection in 2012. But while the rest of the country rebounded, this Rust Belt city and the rest of the county, including Vice President Joe Biden’s hometown of Scranton, across the border in Lackawanna County, were slow to recover.

Many jobs returned, but not many were the good-paying kind that could support a middle-class life. And those who opted to stay in Wilkes-Barre became disappointed and resentful.

“They want the jobs they had before, not the jobs that are available now,” said Kathy Bozinski, the marketing and communications chief at the United Way of Wyoming Valley. “A lot of good things happened during the Obama Administration, but a lot of the things the folks here were hoping for just didn’t happen.”

In November, Luzerne County voted for Donald Trump instead of Hillary Clinton, handing the Republican a narrow but shocking victory that helped propel him to the White House.

“I hate to use the cliché, but there are a lot of angry white guys in the region who 20 years ago were making decent money,” Bozinski said. “Now they are struggling to pay the mortgage and have a good life. There is a lot of frustration.”

Mary Wallace, who is Lisman’s office administrator, said for many people leaving Wilkes-Barre for a better life somewhere else is not an option.

“It’s hard for people who have been here for generations, whose families are buried here, to pick up and move even if they might be better off somewhere else,” she said. “This is their home.”

The most unhappy place in the United States

Two years ago, a pair of researchers — one from Harvard, the other from the University of British Columbia in Vancouver, Canada — concluded that the Scranton/Wilkes-Barre metro area was the most unhappy place in the U.S.

They reached their conclusion after wading through the results of telephone polls conducted by the federal Centers for Disease Control and Prevention between 2005 and 2009, including answers to the question, “How satisfied are you with your life?”

Lisman, whose four grown children did not return to the Wilkes-Barre area after finishing college, agreed that they live in a depressed community.

“We have a lot of people who are unhappy with life,” he said. “People using drugs are looking to escape.”

For Lisman, the heroin plague “is a symptom of the way people here feel and have felt for years.”

“I don’t have an answer for opiate addiction,” he said, his smile fading fast. “The pain and suffering that it has caused is unbelievable. It is eating away at the core of society.”

Ryzner said the people she sees are dealing with a host of demons beyond the economic, everything from sexual abuse and broken homes to being raised in households where drinking and drug-taking runs rampant. She’s seen people who get hooked on prescription drugs make the move to heroin.

“But I can’t just blame the doctors,” she said. “It’s a little bit of economics, little bit of hardship, little bit of being raised like that.”

Drugs like heroin, she said, “makes all your problems melt away.”

“It masks any kind of hurt, any kind of feeling…after three days of doing opiates you are addicted,” she said. “You don’t even know you’re getting caught up.”

And Ryzner would know. She was a drug addict for three decades and has been clean for 10 years.

Cathy Ryzner is a former addict and is currently a Certified Recovery Specialist with Wyoming Valley Alcohol and Drug Services, Inc.NBC News

Death by drug overdose ‘just not natural’

It was against this backdrop that the heroin plague hit the region.

Coroner Lisman, whose dad was once the mayor of Wilkes-Barre, said that at first he made a point of personally going to the scenes when a suspected fatal overdose was reported. No more.

“Now it’s become so routine,” said Lisman, who has gone back to dispatching his deputies to do the grim work of taking the bodies to the morgue.

But Lisman said he is very much aware of what this plague is doing to his hometown and admits it has left him shaken.

“I was raised in an apartment above a funeral home … death never scared me,” he said.

What bothers him, he said, is the resignation he has seen in the victims’ families ones who react “almost with relief.”

“It bothers me that somebody’s life could reach a point that death could be a positive thing,” he said.

This from a man who has comforted thousands of people over the years whose loved ones died of natural causes, sometimes after enduring years of pain.

“Death by drug overdose is different,” he said. “That’s just not natural.”

One case in particular still haunts him. The police had gotten a 911 call and arrived to find a young couple in their 30s dead in bed from “a hot load of heroin while their 5-year-old son was watching TV and eating Cheerios,” Lisman said. “He knew enough to call the police for help.”

Death behind closed doors

The heroin plague in Wilkes-Barre is largely hidden with death taking drug abusers behind closed doors.

“You don’t see junkies on the street,” said Bozinski, who was previously an Emmy Award-winning TV and radio reporter. “This happens behind closed doors. In bedrooms and basements.”

But the effects ripple across the city and touch everyone.

“Everywhere you go you hear, ‘Did you see the story about that one in the paper? Was that another drug overdose?” said Wallace. “That’s what everyone here is talking about.”

The toll is not just psychic. Crime is up, police report, especially petty thefts and break-ins by drug abusers looking for money to score a fix. And the dealers are almost always out-of-towners.

“They’re not racist,” Bozinski said of Wilkes-Barre’s residents. “Yes, some white guys blame people from outside for bringing drugs here. But there’s also the acknowledgement that there is a market for it here.”

“We’re behind the times,” said 42-year-old Paul Smith, who was born and raised in the city — and who buried his former partner Jeremy three weeks earlier after he died of a heroin overdose. “A lot of the problems that were happening in other places are now happening here.”

Sitting in a local bar called Hun’s Café 99 and nursing a beer and a basket of chicken wings, Smith said Jeremy didn’t know what he was dealing with when he started snorting heroin.

“It’s been a very hard thing,” he said. “I spent a lot of time helping him to get clean. It was a very hard reality. And it was very hard to find services to help him.”

Smith said people in Wilkes-Barre turn to drugs because they are already depressed about their lives, depressed that they have to work two or three jobs to get by.

“That’s why people went for Trump,” said Smith, who runs a limo service, owns real estate — and admits to voting for the Manhattan mogul as well. “People are so sick of other people doing better.”

Sitting beside Smith was 28-year-old John Sabatelli. He agreed that it was ignorance of dangerous new variety of heroin that was fueling the crisis. He recalled being surprised when he discovered that a couple at the warehouse where he works was getting high on heroin in the bathroom.

“It’s surprising in that you don’t know who is going to do it,” he said.

Grieving dad Christopher Emmett said drugs have got a death grip on his community. He said his doomed son started smoking pot at age 13 and quickly graduated to harder drugs. He said Christopher Jr. was in and out of rehab — and so were most of his friends.

“It is really an epidemic,” Emmett said. “We went to 14 funerals of my son’s friends who died of addiction in just one year. They’re dropping like flies, every day.”

Emmett’s wife, Patricia, burst into tears at the thought of spending Christmas without her son. And as she cried, her boy’s ashes sat in an urn on a shelf in the living room.

“There ain’t no Christmas,” she said, bitterly.

A proud town fights on

Wilkes-Barre may be down now but it is far from defeated. In Public Square, new restaurants like Franklin’s have opened to serve the young professionals who have moved downtown to live in loft apartments in some of the vintage buildings.

Wilkes-Barre, Pennsylvania.NBC News

Older establishments like the Café Toscana were bustling with diners on a Tuesday night. And so was the brand new Chick-fil-A, which is located on the first floor of a dorm that King’s College built right on the square in an attempt to make students part of the city’s revival.

Just outside downtown loomed the rotting hulks of long-abandoned factories. But higher up in the hills, Christmas lights twinkled on many of the modest-but-clearly kept up homes and the streets bustled with families going about the business of everyday life.

Over at the ornate county courthouse, which dates back to 1909 and which was built at a time when the future of Wilkes-Barre seemed bright, a chorus of fourth graders from a school across the river in Larksville filed into the central hall to perform a medley of Christmas carols.

Watching them was the grandmother of one 11-year-old, a chubby, brown-haired boy with untied gym shoes. His face creased into an angelic smile when he spotted his grandma.

“I am scared for him,” said the grandmother, who declined to give her name. “I have family that got hooked on drugs. I don’t want that to happen to him.”

Asked why the area has been so ravaged by drugs, she shook her head. “I don’t know, maybe because they’re so easy to get,” she said.

The children’s music teacher, Joseph James, said so far his kids “are completely sheltered” from the heroin crisis unfolding around them.